In the Hollywood version of mental illness, sufferers are almost always violent, usually kill or maim innocent victims and are not infrequently triggered into carrying out savage deeds by innocuous events such as a full moon, Halloween, or Friday the 13th.
And those few mentally ill people on film who neither kill nor scare the neighbours are usually cured with an hour or two on the couch with a sympathetic shrink and follower of Freud who, for good measure, may well fall in love with them.
In the Hollywood treatment of mental illness, patients are stigmatised as either being incurably violent, or as people suffering problems so minor they can all be solved by love and affection, says Dr Cleo Van Velsen, consultant psychiatrist at the Maudsley Hospital in south London.
The results of her research into mental illness in the movies come amid growing concern that the mentally ill remain stigmatised and discriminated against. Many people still wrongly believe, for instance, that all people with schizophrenia are violent. In fact only a very small number of all people who are mentally ill are in any way violent towards other people.
Dr Van Velsen has made a study of Hollywood's treatment of mental illness over the past six decades and has found that the movie-makers almost always get it wrong.
"Mentally ill people are often wrongly portrayed as violent and that perpetuates the myths about all or the majority of patients being violent. In The Silence of the Lambs, for example, we have the portrayal of an unstable man who is extremely violent. In Psycho you have the sense of violence and the secret basement world, and generally odd people. There is also the danger and violence in Halloween where the man escapes from an asylum," says Dr Van Velsen, who has produced the results of her research for World Mental Health Day, which takes place today.
"Final Analysis with Richard Gere is another bad example, and so too is Copycat where the patient becomes obsessed with the forensic psychiatrist and tries to kill her."
She says that mentally ill patients also have their illnesses trivialised: "In a lot of the films there is the underlying message that all the patient really needs is love and affection. There is a tendency in films to try and normalise mental illness by saying that patients don't need treatment, they need love. The audience gets the two extremes and what we are not getting are portrayals of people with chronic illness."
Another Hollywood favourite is the cathartic cure (Suddenly Last Summer and The Three Faces of Eve) where the psychiatrist unlocks a secret from the past which leads to an outpouring of emotion and a cure.
Yet another common plot is the psychiatrist who gets involved with a patient and turns detective to solve the patient's other problems (David and Lisa, and Snakepit).
Dr Van Velsen says that psychiatrists often get a raw deal too in the madness-movie genre, with men portrayed as eccentric, even mad, and sometimes evil (Dressed to Kill and One Flew Over the Cuckoo's Nest), while women shrinks are simply waiting for the right male patient to come along.
"In many movies treatment leads to feelings of love and sex (Spellbound, Prince of Tides, Wild in the Country, Mr Jones). Women psychiatrists are often shown as single, repressed, rather rigid women who need "the love of a good man" in order for them to become a real woman. "This is usually crudely symbolised by her letting down her hair and taking off her dark- rimmed glasses," she says.
"But, of course, as a psychiatrist you don't sleep with your patients, or fall in love, or go around the country solving murders and mysteries with them. Mr Jones with Richard Gere, for example, is one of the few attempts to portray a severe mental illness, but what the female psychiatrist does is quite frightening.
"It's a dangerous message that the psychiatrist falls in love with a patient because she is being true to her feelings. If I am sitting with a seductive psychopath and he has erotic thoughts towards me, it's erotic transference, it's not love."
There are some films, says Dr Van Velsen, which are not all bad, and she gives marks for authenticity to Richard Burton's Equus, made in 1977: "... there is a real sense of someone who is psychotic and interesting."
At the opposite extreme there is Wild in the Country where a young Elvis Presley is diagnosed as being a delinquent and in need of professional counselling in the shape of Hope Lang who is, naturally, overcome at their first meeting.
As she is grabbed by Presley, she half protests, while unpinning her hair and taking off her glasses: "We can't do this, it's wrong," she whispers. "We call it transference."
"Honey," pouts a mean Elvis as he embraces her, "I call it love."
One Flew over the Cuckoo's Nest (1975)
A maverick prisoner (Jack Nicholson) is transferred to a state mental hospital where he energises the patients so much that the staff carry out a lobotomy that leaves him catatonic. Dr Van Velsen's verdict: "Puts forward the view that society is mad and not patients, and that psychiatrists exist only to further their own careers and stop people speaking out. Allegory of a fascist state with a concentration camp and a cruel commandant. We shouldn't pretend that mental illness doesn't exist."
A disturbed boy blinds six horses in the stable where he works and is referred to a psychiatrist (Richard Burton) for a report. The doctor unravels a complex web of religion and sexuality, and begins to envy the boy who worships the god Equus. Verdict: "Although the violent young man blinds the horses and there is that violence there, the film has a real sense of someone who is psychotic. A very interesting film."
The Silence of the Lambs (1991)
Thriller about a serial killer who partially skins his female victims, and an ambitious FBI trainee who tries to catch him with the help of the imprisoned Dr Hannibal Lecter.
Verdict: "Like a Grimm's fairy tale - and Hannibal Lecter is such an extreme character and a truly perverse person. The problem with these kind of films is that people will associate characters like Lecter and Anthony Perkins in `Psycho' with all people who are mentally ill. They are taken to be representative of mental illness."
Final Analysis (1992)
A psychiatrist (Richard Gere) becomes involved with his patient's sister who kills her
husband, but the doctor becomes the main suspect.
Verdict: "Very poor film. Very unconvincing portrayal of a psychiatrist, and [it] gets round the slippery problems of a doctor bonking his patient by having him have a relationship with her sister. The one who is supposed to be distressed or depressed and her sister the vamp are both over-the- top characters."Reuse content